Jessica and Fred Leavitt's book, Improving Medical Outcomes, is an ambitious and far-reaching effort to suggest ways of delivering better health outcomes in a wide variety of areas. Its focus is mostly on lower-level grassroots interventions—those that can be implemented by individual physicians and patients. It does not, for the most part, examine ways in which fundamentally redesigning the health care system as a whole, or some of the frameworks such as health networks or hospitals in which medical care is provided in this country, might lead to added value on a much larger scale.